Policy responses and statements

Name of organisation:

Scottish Parliament: Health Committee

Name of policy document:

Certification of Death (Scotland) Bill (SP Bill 58) - Health and Sport Committee Call For Evidence

Deadline for response:

18 November 2010

Background: The Health and Sport Committee launched a public call for written evidence from all interested parties on the general principles of the Certification of Death (Scotland) Bill. This Bill was introduced in the Scottish Parliament by the Scottish Government on 7 October 2010.

The Policy Memorandum which accompanies the Bill states that its main objectives of the Bill are to —

• Introduce a new system in Scotland for the scrutiny of medical certificates of cause of death;
• Create the post of medical reviewer and senior medical reviewer, whose functions will be to review for accuracy the certificates referred to them;
• Where a person has died outwith Scotland and the body is to be cremated in Scotland, medical reviewers will determine whether it is safe to cremate the body. They may also instruct a post-mortem in such cases from outwith the UK if no cause of death is available;
• Provide for the form of medical certificates of cause of death to be amended to show additional relevant medical information to indicate, for example, whether it is safe to dispose of the body by cremation, and
• Make it an offence to dispose of a body or body parts without authorisation.

Call for written evidence:

The Committee invited evidence from individuals as well as from organisations and professional bodies. The Committee intends that evidence received will inform its consideration of the Bill at Stage 1.

The Committee invited views on all aspects of the Bill. Responses were invited on any or all of the following points -

• Do you agree or disagree with the general principles of the Bill?
• Do you agree with the proposed changes to the system of death certification in Scotland?
• Do you agree with the proposed creation of a system of Medical Reviewers?
• Do you have any comments on the costs identified in the Financial Memorandum?
• Are there any other comments you wish to make on the Bill?

Comments on
Scottish Parliament: Health Committee
Certification of Death (Scotland) Bill

The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the Scottish Parliament’s consultation on the Certification of Death (Scotland) Bill.

The College supports moves to streamline processes and reduce cremation costs.  Answers to the consultation questions are set out below.

Consultation Questions

• Do you agree or disagree with the general principles of the Bill?

  The College agrees with the policy aims underpinning the Bill, namely to,

• introduce a single system of independent, effective scrutiny applicable to deaths that do not require an investigation by the Procurator Fiscal;
• improve the quality and accuracy of the medical certificate of cause of death form; and
• provide improved public health information and strengthened clinical governance in relation to deaths.

The College also supports moves to improve the efficiency and cost of death certification for the majority of families and the removal of inconsistencies between the processing and scrutiny of cremations and burials.

• Do you agree with the proposed changes to the system of death certification in Scotland?

In general, the College supports the proposed changes to provide for a single signatory to certify death in Scotland.

However, the College has several concerns including:

• the need for a threshold test and shorter time limit in relation to interested person reviews; and
• the impact of delays caused by random reviews of death certificates upon families.

Interested person reviews

It is noted that the proposed system appears to require the Medical Reviewer to review a death certificate where requested by an interested person, unless the application is vexatious.  It may be difficult for the Medical Reviewer to determine whether an application is vexatious, meaning that the Reviewer may end up reviewing the majority of applications he or she receives.  This could involve applications from persons who don’t “like” the cause of death noted by the certifying doctor. 

To ensure efficiency and fairness, the College considers that there a need for the introduction of a threshold test describing the circumstances within which an interested person can seek a review.  For example, the person could be required to demonstrate that they are concerned that the cause of death listed may not represent a reasonable conclusion as to the likely cause of death and/or a belief that other information contained in the certificate may be incorrect.  An appeal mechanism would also need to be built into such a system.

Consideration could be given to whether such a test should be incorporated in the legislation or introduced as guidance after the passage of the Bill.

There is also concern that the 3 year time limit within which an interested person may seek a review is too long a time period to allow a meaningful review to take place.

Concern for families

The College is concerned about the impact of intervention and delays where deaths are randomly selected for scrutiny pre-registration.

It is noted that the Government anticipates that scrutiny will have minimal impact on the scheduling of funerals, and that, in certain circumstances, families will be able to request that the registration of the death takes before the review is completed.  Registration will only be allowed where the Medical Reviewer is satisfied that the circumstances of the case justify registration and there are no obvious indications that the medical certificate is not in order.

It may be extremely distressing for families to have someone intervening where the family perceives there is no issue and where they are not eligible for the expedited registration procedure.

Early consideration must be given to who will be responsible for explaining to families the possibility that the certificate may be selected for review or the subject of a review application from an interested person, and at what point this should occur.  That person must be appropriately trained and readily accessible to the family.  Once a certificate is selected for review, the process and timescales should be explained to affected families in person.

Delays during reviews must be kept to a minimum and timescales should be set out in guidance accompanying the legislation.  It is imperative that the process is speedy, transparent and properly explained to avoid undue distress to bereaved families.

• Do you agree with the proposed creation of a system of Medical Reviewers?

  Yes.

• Do you have any comments on the costs identified in the Financial Memorandum?

  The College welcomes proposals to replace cremation fees with a modest certification fee for both cremations and burials to fund the running costs of the new certification system.  This will reduce costs for the majority of families and offers a more equitable system.

• Are there any other comments you wish to make on the Bill?

  The College is supportive of moves to include more medical information on death certificates regarding surgical implants and public health risks, which should also improve statistical recording of such information.  The College welcomes the General Register for Office’s proposed inclusion of the Community Health Initiative (CHI) number on the form.

  In order to improve the accuracy of death certificates, the College recommends that a doctor of Specialist Registrar level or higher should always be involved in the issue of a certificate.

  The College acknowledges that legislative amendment cannot prevent Shipman-style cases, and should be driven instead by broader patient safety initiatives. 

Dr A D Dwarakanath FRCP Edin
Secretary
Royal College of Physicians of Edinburgh
9 Queen Street
Edinburgh
EH2 1JQ

17 November 2010

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[17 November 2010]